dch/navigant medicaid & peachcare strategy report
DESCRIPTION
DCH/Navigant Medicaid & PeachCare Strategy Report. Medical Association of Georgia February 4, 2012. Cam Grayson. Purpose of DCH Redesign. Formulate strategy for future of Medicaid and PeachCare for Kids Comprehensive assessment of programs to identify redesign options. DCH Redesign Goals. - PowerPoint PPT PresentationTRANSCRIPT
DCH/Navigant Medicaid & PeachCare
Strategy Report
Medical Association of GeorgiaFebruary 4, 2012Cam Grayson
Building a Better State of Health Since 1849
Purpose of DCH Redesign
Formulate strategy for future of Medicaid and PeachCare for Kids
Comprehensive assessment of programs to identify redesign options
DCH Redesign Goals
Enhance appropriate use of services by members
Achieve long-term sustainable savings in services
Improve health care outcomes for members
Building a Better State of Health Since 1849
DCH Redesign Strategies
Gain administrative efficiencies
Ensure timely and appropriate access
Ensure operational feasibility
Align reimbursement with patient outcomes, quality
Encourage members to be accountable for own health
Develop a scalable solutionBuilding a Better State of Health Since 1849
Approach/Content
Project goals Study methodology and limitations National environmental scan Georgia-specific scan Options for Georgia’s design strategy Appendices
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Evaluating the Options
Phase I: Evaluate generic delivery system options
Phase II: Assess potential services and populations to “carve in” or “carve out”
Phase III: Develop and evaluate Georgia-specific delivery system option
Phase IV: Identify recommendations
Building a Better State of Health Since 1849
Delivery Systems
Building a Better State of Health Since 1849
Source: Navigant Medicaid and PeachCare for Kids Design Strategy Report, January 17, 2012, page 3-19
Generic Delivery Systems Selected
Option 6: Georgia Families Plus Option 8: “Commercial Style” Managed
Care Option 9: Free Market Health Insurance
Purchasing
Building a Better State of Health Since 1849
Navigant “Carve Ins” (Population-Based)
Behavioral health services Long-term care services Home and community-based waivers Dually eligible for Medicaid and
Medicare Foster care children
Building a Better State of Health Since 1849
Navigant “Carve Ins” (Service-Based)
Behavioral health services LTC services Home and community-based waiver Dental services Transportation services Pharmacy services
Building a Better State of Health Since 1849
Rationale for “Carve-Ins”
Populations lack care management Streamlines single delivery system Clinical information linkages Limits patient confusion by one entity Cost efficiencies and improves quality Reduces administrative oversight
Building a Better State of Health Since 1849
Rationale for “Carve-Ins”
Vendors can leverage with providers to enforce coordination of care and outcomes using PFP and value-based purchasing
One blended/capitated rate for all services under one contract stops “dumping”
Building a Better State of Health Since 1849
Permutations to Generic Delivery
System Option 1: Georgia Families Plus Option 2: Georgia Families Plus
transitioning to “commercial style” managed care program
Option 3: Georgia Families Plus transitioning to “commercial style” managed care program using ACOs and PCMHs
Option 4: Georgia Families Plus and free market health insurance purchasingBuilding a Better State of Health Since 1849
Underlying Assumptions
Delivery system can be implemented and applied to all populations on statewide basis
DCH can introduce on incremental basis, beginning with traditionally managed populations and adding more complex populations in future
Building a Better State of Health Since 1849
Recommended Delivery Systems
1. Georgia Families Plus transitioning to “commercial style” managed care program that require ACOs and PCMHs
2. Georgia Families Plus transitioning to “commercial style” managed care program
3. Georgia Families Plus
Building a Better State of Health Since 1849
Option 1: Georgia Families Plus
Enrolls all populations (foster care, dual eligibles, ABD) and all services
Uses value-based purchasing, performance measures
Uses medical homes Obtains compliance using patient
incentives Focuses on health and wellness Offers risk-based budget predictability
Building a Better State of Health Since 1849
Option 2: Georgia Families
Plus/Commercial Option 1 plus commercial managed care
levers Many enrolled in commercial managed
care Uses copayments, deductibles, HRAs,
incentive payments, and prizes Initially excludes foster care, ABD, dual-
eligibleBuilding a Better State of Health Since 1849
Option 3: Georgia Families Plus/Commercial + Managed
Care/ACOs/PCMHs
Enroll many in commercial-style managed care
Similar to former plan but requires ACOs and PCMHs
Foster care, ABD, and dual-eligible not initially targeted
Risk-based managed care
Building a Better State of Health Since 1849
Option 4: Georgia Families Plus + Free Market Health
Insurance Purchasing
Implements Georgia Families Plus for children, foster care, ABD
Free market health insurance purchasing program
Allows patient choice of plans Maximizes budget predictability
Building a Better State of Health Since 1849
Free Market Approach
DCH defines standard benefit package Insurers would offer standard benefit
package and health rewards account Insurers would seek certification from
state and limit participation to less than six insurers
DCH would not contract directly with health plans and would not process claims
Medicaid members given a credit to purchase
Building a Better State of Health Since 1849
Next Steps for DCH
Select delivery system and “carve-in” populations and services
Improve DCH internal operational issues such as credentialing, eligibility system, CMO contract monitoring
Consider and decide on redesign
Building a Better State of Health Since 1849
Key Design Options
Delivery system leverages HRAs, HSAs Care and disease management Medication therapy management Contracted vendors Special populations Payment strategies Penalties and rewards
Building a Better State of Health Since 1849
Implementation and Operational Needs
Federal approvals Determining basis for
populations/timelines DCH needs to change its organizational
structure Determine what other information
systems and operational changes are necessary
Building a Better State of Health Since 1849
Planning for Key Design and Program
Features Develop high-level implementation
timeframe Convene team to develop
recommendations for detailed program Convene advisory groups as needed Vet program design with stakeholders Develop strategies to mitigate risks Develop implementation plan and
timeline Building a Better State of Health Since 1849
